US7749235B2 - Stomach invagination method and apparatus - Google Patents

Stomach invagination method and apparatus Download PDF

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Publication number
US7749235B2
US7749235B2 US11/551,406 US55140606A US7749235B2 US 7749235 B2 US7749235 B2 US 7749235B2 US 55140606 A US55140606 A US 55140606A US 7749235 B2 US7749235 B2 US 7749235B2
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United States
Prior art keywords
stomach
adhesive
invaginated
vacuum
tissue
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US11/551,406
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US20080147112A1 (en
Inventor
John Wesley Sheets, Jr.
Mark S. Ortiz
Fredrick E. Shelton, IV
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Ethicon Endo Surgery Inc
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Ethicon Endo Surgery Inc
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Priority to US11/551,406 priority Critical patent/US7749235B2/en
Assigned to ETHICON ENDO-SURGERY, INC. reassignment ETHICON ENDO-SURGERY, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: ORTIZ, MARK S., SHELTON, FREDERICK E., IV, SHEETS, JOHN WESLEY, JR.
Priority to JP2007272952A priority patent/JP2008110210A/ja
Priority to EP07254150A priority patent/EP1913880B1/en
Priority to AT07254150T priority patent/ATE505137T1/de
Priority to CN200710167644XA priority patent/CN101172049B/zh
Priority to DE602007013853T priority patent/DE602007013853D1/de
Publication of US20080147112A1 publication Critical patent/US20080147112A1/en
Priority to HK08109694.2A priority patent/HK1118431A1/xx
Publication of US7749235B2 publication Critical patent/US7749235B2/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00491—Surgical glue applicators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/30—Surgical pincettes without pivotal connections
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
    • A61F5/0003—Apparatus for the treatment of obesity; Anti-eating devices
    • A61F5/0013—Implantable devices or invasive measures
    • A61F5/0083—Reducing the size of the stomach, e.g. gastroplasty
    • A61F5/0086—Reducing the size of the stomach, e.g. gastroplasty using clamps, folding means or the like
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06166—Sutures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
    • A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2905—Details of shaft flexible
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/30—Surgical pincettes without pivotal connections
    • A61B2017/306—Surgical pincettes without pivotal connections holding by means of suction

Definitions

  • FIG. 1 depicts an exemplary suction device within a stomach, and an exemplary method for applying adhesive to an outer wall of the stomach;
  • FIG. 2 depicts a partial cross-sectional view of the suction device of FIG. 1 engaged with a stomach;
  • FIG. 3 depicts a cross-sectional view of exemplary invaginated stomach portions
  • FIG. 4 depicts a cross-sectional view of the invaginated stomach portions of FIG. 3 detached from the inner stomach wall;
  • FIG. 5 depicts a plan view of an exemplary adhesive matrix applied to an outer stomach wall
  • FIG. 6 depicts a plan view of the outer stomach wall of FIG. 5 after the wall has been invaginated
  • FIG. 7 depicts a partial view of an exemplary alternative invagination device
  • FIG. 8 depicts the invagination device of FIG. 7 performing an exemplary act of invagination
  • FIG. 9 depicts a partial cross-sectional view, taken along line 9 - 9 of FIG. 8 , of the invagination device of FIG. 7 performing an exemplary act of invagination;
  • FIG. 10 depicts a perspective view of an exemplary alternative gripping jaw member
  • FIG. 11 depicts a partial cross-sectional view of an exemplary alternative invagination device with the gripping jaw member of FIG. 10 ;
  • FIG. 12 depicts a partial cross-sectional view of the device of FIG. 11 with the gripping jaw members in a generally open position.
  • an exemplary invagination system ( 10 ) comprises a suction device ( 20 ) and an endoscopic adhesive applier ( 40 ).
  • suction device ( 20 ) is disposed within a stomach ( 100 ); while adhesive applier ( 40 ) is positioned outside stomach ( 100 ).
  • invagination system ( 10 ) is operable to create several invaginated portions ( 102 ) of stomach ( 100 ). The creation of such invaginated portions ( 102 ) may ultimately reduce the volume of stomach ( 100 ).
  • the suction device ( 20 ) comprises a head ( 22 ) coupled with a flexible tube ( 24 ).
  • head ( 22 ) has an annular, outwardly flared rim ( 26 ), and is in fluid communication with flexible tube ( 24 ).
  • Rim ( 26 ) is configured to sealingly engage an inner stomach surface ( 104 ).
  • a vacuum may be provided through flexible tube ( 24 ) to draw a portion of stomach ( 100 ) into head ( 22 ), thereby creating an invaginated portion ( 102 ) of stomach ( 100 ).
  • the illustrated configuration for head ( 22 ) is merely exemplary, and that head ( 22 ) may alternatively comprise a variety of alternative features and configurations.
  • adhesive applier ( 40 ) of the present example is configured to fit within a working channel of an endoscope ( 50 ).
  • Adhesive applier ( 40 ) in this example is a conventional endoscopic adhesive applier, though any suitable alternative may be used.
  • Adhesive applier ( 40 ) is operable to dispense an adhesive ( 60 ) on an outer surface ( 106 ) (e.g., serosal surface) of stomach ( 100 ).
  • Adhesive ( 60 ) may comprise a cyanoacrylate, an isocyanate, or any other suitable substance.
  • a matrix cloth ( 70 ) may be applied to outer surface ( 106 ) of stomach ( 100 ) before adhesive ( 60 ) is applied.
  • Matrix cloth ( 70 ) may comprise a plurality of cells ( 72 ), such as in a honeycomb configuration by way of example only. Each cell ( 72 ) may comprise an activator substance that is configured to react with adhesive ( 60 ).
  • adhesive ( 60 ) may be configured such that it is not operable to satisfactorily adhere tissue unless placed in contact with the activator substance.
  • matrix cloth ( 70 ) may lack an activator substance.
  • matrix cloth ( 70 ) may comprise polyester or any other suitable material or materials.
  • matrix cloth ( 70 ) contains adhesive ( 60 ), such that a separate applier ( 40 ) is not needed to apply adhesive ( 60 ).
  • cells ( 72 ) may contain adhesive ( 60 ).
  • matrix cloth ( 70 ) material may itself be adhesive, with no adhesive ( 60 ) being provided within cells ( 72 ).
  • portions of matrix cloth ( 70 ) may adhere to outer surface ( 106 ) and/or to other portions of matrix cloth ( 70 ). This may permit contact between adjacent outer surface ( 106 ) portions through voids provided by empty cells ( 72 ), which may result in fusion of such adjacent outer surface portions ( 106 ).
  • matrix cloth ( 70 ) may be substituted with any suitable alternative, supplemented with other structures or substances, or may be omitted altogether. To the extent that a matrix cloth ( 70 ) is used, suitable methods for applying matrix cloth ( 70 ) will be apparent to those of ordinary skill in the art.
  • head ( 22 ) is applied to stomach ( 100 ) opposite of applied adhesive ( 60 ) and matrix cloth ( 72 ).
  • adhesive ( 60 ) and matrix cloth ( 72 ) are also pulled in with invaginated portion ( 102 ).
  • adhesive ( 60 ) is entrained in the interior portion of invaginated portion ( 102 ). It will be appreciated that adhesive ( 60 ) may provide sufficient adhesion to maintain the configuration of invaginated portion ( 102 ).
  • adhesive ( 60 ) is applied after invaginatied portion ( 102 ) has been created.
  • adhesive applier ( 40 ) may be pressed into the well provided in outer surface ( 106 ) by invaginated portion ( 102 ).
  • Adhesive ( 60 ) may be applied until it begins excreting from within the well or until otherwise desired.
  • one or more sutures ( 80 ) are applied at or near the base of each invaginated portion ( 102 ) to further assist the maintenance of invaginated portion ( 102 ) configurations (and/or for other purposes). Sutures ( 80 ) may also cut of blood circulation for each invaginated portion ( 102 ), resulting in the death of tissue forming each invaginated portion ( 102 ).
  • any suitable alternative to sutures ( 80 ) may be used, including but not limited to bands, clips, staples, etc.
  • sutures ( 80 ) may be substituted, supplemented, or omitted altogether, as desired.
  • invaginated portions ( 102 ) may eventually separate from stomach ( 100 ) (e.g., after at least a portion of the tissue forming invaginated portions ( 102 ) necroses or dies). Such separated invaginated portions ( 102 ) may thereafter pass through the gastrointestinal tract. At sites ( 108 ) where each invaginated portion ( 102 ) was formerly located, a remaining amount of adhesive ( 60 ) may prevent an opening from forming through stomach ( 100 ). In addition, or in the alternative, scar tissue or other tissue fusion may prevent the formation of such openings.
  • stomach ( 100 ) the structural integrity of stomach ( 100 ) will be preserved despite the separation of invaginated portions ( 102 ) from their respective sites ( 108 ). It will also be appreciated that the separation of invaginated portions ( 102 ) may cause a reduction in acid producing surface. To the extent that invagination system ( 10 ) is used to treat obesity, such a reduction in acid producing surface may further provide a desirable malabsorbative result. Such a malabsorbative result may compliment reduction in stomach volume caused by invagination as a means for addressing obesity.
  • FIGS. 7-9 depict a gripping instrument ( 120 ) that may be used as an alternative to suction device ( 20 ).
  • gripping instrument ( 120 ) comprises a shaft ( 122 ) and a pair of gripping jaw members ( 124 ).
  • Shaft ( 122 ) is generally flexible, and is configured to be introduced to a patient's stomach ( 100 ) through the patient's esophagus (e.g., endoscopically, etc.).
  • shaft ( 122 ) further comprises a lumen (not shown) through which a vacuum may be provided.
  • Gripping jaw members ( 124 ) are pivotally connected relative to shaft ( 122 ), such that jaw members ( 124 ) may be selectively provided in an open or closed positions.
  • Each gripping jaw member ( 124 ) has a plurality of teeth ( 126 ).
  • Teeth ( 126 ) are configured to grip tissue, such as inner stomach surface ( 104 ).
  • Gripping jaw members ( 124 ) may be operable to open and close via cables (not shown). Cables in the present example extend through shaft ( 122 ) to a user input device (not shown). Of course, any suitable alternative to cables may be used to open and/or close gripping jaw members ( 124 ).
  • Gripping instrument ( 120 ) of the present example further comprises a vacuum port ( 140 ).
  • Vacuum port ( 140 ) may have a configuration similar to that of head ( 22 ) on suction device ( 20 ).
  • vacuum port ( 140 ) has a diameter that is less than the diameter of head ( 22 ) on suction device ( 20 ).
  • Vacuum port ( 140 ) is in fluid communication with vacuum lumen of shaft ( 122 ). Vacuum port ( 140 ) may be used to secure inner stomach surface ( 104 ) relative to gripping jaw members ( 124 ), such as before gripping jaw members ( 124 ) are used to grip inner stomach surface ( 104 ).
  • matrix cloth ( 70 ) and adhesive ( 60 ) are applied to outer stomach surface ( 106 ).
  • Gripping instrument ( 120 ) is positioned adjacent inner stomach surface ( 104 ), substantially opposite of matrix cloth ( 70 ) and adhesive ( 60 ).
  • vacuum is applied through vacuum port ( 140 ), securing inner stomach surface ( 104 ) relative to gripping jaw members ( 124 ), as shown in FIG. 7 .
  • Gripping jaw members ( 124 ) are then actuated to a substantially closed position while gripping inner stomach surface ( 104 ) with teeth ( 126 ), as shown in FIGS. 8-9 .
  • An invaginated portion ( 202 ) is thereby created in stomach ( 100 ).
  • invaginated portion ( 202 ) is similar to invaginated portion ( 102 ), except that invaginated portion ( 202 ) is generally wider in one dimension. It will therefore be appreciated that creation of invaginated portion ( 202 ) may result in greater reduction of stomach ( 100 ) volume than creation of invaginated portion ( 102 ). It will also be appreciated that the base of invaginated portion ( 202 ) may be further secured with one or more sutures, bands, clips, staples, etc.
  • gripping instrument ( 120 ) comprises a shaft ( 222 ) and a pair of gripping jaw members ( 224 ).
  • Shaft ( 222 ) is generally flexible, and is configured to be introduced to a patient's stomach ( 100 ) through the patient's esophagus (e.g., endoscopically, etc.).
  • shaft ( 222 ) further comprises a lumen ( 250 ) through which a vacuum may be provided.
  • Gripping jaw members ( 224 ) are pivotally connected relative to shaft ( 222 ), such that jaw members ( 224 ) may be selectively provided in an open or closed positions.
  • Each gripping jaw member ( 224 ) has a plurality of teeth ( 226 ).
  • Teeth ( 226 ) are configured to grip tissue, such as inner stomach surface ( 104 ).
  • Gripping jaw members ( 224 ) may be operable to open and close via cables ( 230 ). Cables ( 230 ) in the present example extend through shaft ( 222 ) to a user input device (not shown). Of course, any suitable alternative to cables ( 230 ) may be used to open and/or close gripping jaw members ( 224 ).
  • Each gripping jaw member ( 224 ) comprises a generally spherically-shaped joint portion ( 228 ). Joint portions ( 228 ) are configured to overlap within shaft ( 222 ) while gripping jaw members ( 224 ) are in an open position. Each gripping jaw member ( 224 ) also has a cup-like configuration, which is configured to provide a vacuum chamber ( 240 ). Such vacuum chambers ( 240 ) are in fluid communication with lumen ( 250 ), such that a vacuum may be provided within vacuum chambers ( 240 ) via lumen ( 250 ). In another variation, a cover (not shown) having a plurality of apertures is provided over each vacuum chamber ( 240 ). Alternatively, any other structural variation of gripping jaw members ( 224 ) may be used.
  • lumen ( 250 ) is depicted as generally being the interior of shaft ( 222 ), it will be appreciated that lumen ( 250 ) may alternatively be provided by a separate member (not shown) inserted through shaft ( 222 ). Other structural variations will be apparent to those of ordinary skill in the art.
  • gripping instrument ( 220 ) is used in a manner similar to the use of gripping instrument ( 120 ) described above. However, instead of suction being provided through vacuum port ( 140 ), suction is provided through vacuum chambers ( 240 ) of gripping jaw members ( 224 ). Such suction may be provided before and during the gripping of inner stomach surface ( 104 ) of teeth ( 226 ), and may assist teeth ( 226 ) in the gripping of inner stomach surface ( 104 ). Suction may continue to be provided as gripping jaw members ( 224 ) are brought to a closed position, whereupon an invaginated portion ( 202 ) is created.
  • invaginated portions ( 102 , 202 ) may result in a reduction of stomach ( 100 ) volume.
  • Such reduction in stomach ( 100 ) volume may (or may not) provide a method for treating morbid obesity in a patient, and/or may provide other results.
  • Other suitable structural variations of suction device ( 20 ) and gripping instruments ( 120 , 220 ), as well as variations of uses for the same, will be apparent to those of ordinary skill in the art.
  • invagination systems ( 10 ) described herein may be used in laparascopic, endoscopic, open, and/or other surgical settings, including combinations thereof.
  • Embodiments of the present invention have application in conventional endoscopic and open surgical instrumentation as well as application in robotic-assisted surgery.
  • Embodiments of the devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. Embodiments may, in either or both cases, be reconditioned for reuse after at least one use. Reconditioning may include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, embodiments of the device may be disassembled, and any number of the particular pieces or parts of the device may be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, embodiments of the device may be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure.
  • reconditioning of a device may utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.
  • a new or used instrument may be obtained and if necessary cleaned.
  • the instrument may then be sterilized.
  • the instrument is placed in a closed an sealed container, such as a plastic or TYVEK bag.
  • the container and instrument may then be placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons.
  • the radiation may kill bacteria on the instrument and in the container.
  • the sterilized instrument may then be stored in the sterile container the sealed container may keep the instrument sterile until it is opened in a medical facility.
  • a device may also be sterilized using any other technique known in the art, including but not limited to beta or gamma radiation, ethylene oxide, or steam.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Gastroenterology & Hepatology (AREA)
  • Ophthalmology & Optometry (AREA)
  • Child & Adolescent Psychology (AREA)
  • Obesity (AREA)
  • Nursing (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Vascular Medicine (AREA)
  • Surgical Instruments (AREA)
  • Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
  • Steroid Compounds (AREA)
  • Medicines Containing Material From Animals Or Micro-Organisms (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
US11/551,406 2006-10-20 2006-10-20 Stomach invagination method and apparatus Active 2027-10-11 US7749235B2 (en)

Priority Applications (7)

Application Number Priority Date Filing Date Title
US11/551,406 US7749235B2 (en) 2006-10-20 2006-10-20 Stomach invagination method and apparatus
CN200710167644XA CN101172049B (zh) 2006-10-20 2007-10-19 形成胃内褶的器械
EP07254150A EP1913880B1 (en) 2006-10-20 2007-10-19 Stomach invagination apparatus
AT07254150T ATE505137T1 (de) 2006-10-20 2007-10-19 Mageninvaginationsvorrichtung
JP2007272952A JP2008110210A (ja) 2006-10-20 2007-10-19 胃の陥入方法および装置
DE602007013853T DE602007013853D1 (de) 2006-10-20 2007-10-19 Mageninvaginationsvorrichtung
HK08109694.2A HK1118431A1 (en) 2006-10-20 2008-09-01 Stomach invagination apparatus

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
US11/551,406 US7749235B2 (en) 2006-10-20 2006-10-20 Stomach invagination method and apparatus

Publications (2)

Publication Number Publication Date
US20080147112A1 US20080147112A1 (en) 2008-06-19
US7749235B2 true US7749235B2 (en) 2010-07-06

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US11/551,406 Active 2027-10-11 US7749235B2 (en) 2006-10-20 2006-10-20 Stomach invagination method and apparatus

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US (1) US7749235B2 (un)
EP (1) EP1913880B1 (un)
JP (1) JP2008110210A (un)
CN (1) CN101172049B (un)
AT (1) ATE505137T1 (un)
DE (1) DE602007013853D1 (un)
HK (1) HK1118431A1 (un)

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US20150230797A1 (en) * 2006-07-07 2015-08-20 Ethicon Endo-Surgery, Inc. Surgical stapling instrument
WO2020049414A1 (en) 2018-09-05 2020-03-12 Ethicon, Inc. Apparatus for gastric volume reduction utilizing an expandable member

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EP1913880A1 (en) 2008-04-23
DE602007013853D1 (de) 2011-05-26
US20080147112A1 (en) 2008-06-19
HK1118431A1 (en) 2009-02-13
CN101172049B (zh) 2011-11-09
ATE505137T1 (de) 2011-04-15
CN101172049A (zh) 2008-05-07
JP2008110210A (ja) 2008-05-15
EP1913880B1 (en) 2011-04-13

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